Certified Nursing Assistant (CNA) Exam Concept Review

Overview

This chapter covers the everyday personal care a nurse aide gives: bathing, mouth and denture care, grooming, dressing, eating, toileting, and rest. Questions often ask what to do first, how to keep the resident safe, and how to protect dignity while helping.

Safety comes first in personal care. Check bath water temperature before the resident gets in, because older skin burns easily. Give mouth care to an unconscious resident with the resident on the side so fluid drains out of the mouth. Clean dentures over a sink lined with a towel or a little water, and store them wet in a labeled cup. Use an electric razor for residents who take blood thinners.

When dressing a resident with a weak side, dress the weak arm first and undress it last. For meals, sit the resident upright, offer small bites, and let the resident choose the order of foods. NPO means nothing by mouth, and thickened liquids are ordered for residents who have trouble swallowing.

For elimination, wipe from front to back and keep a urinary drainage bag below the bladder and off the floor. Clean catheter tubing from the body outward. Report unusual output such as black, tarry stool. To help prevent pressure injuries, reposition as the care plan says, keep skin clean and dry, and never rub reddened bony areas.

Overview

This chapter explains how germs spread and how a nurse aide stops them. Questions often ask which hand hygiene to use, which protective equipment to wear, and how to handle dirty items.

Hand hygiene is the most important way to prevent the spread of infection. Alcohol-based hand rub is fine for most routine hand hygiene, but hands that are visibly soiled must be washed with soap and water. Gloves never replace hand hygiene, so clean your hands after removing gloves. Change gloves between residents and when moving from a dirty task to a clean task.

Standard precautions are used for every resident, every time, because you cannot tell who carries germs. Some residents also need transmission-based precautions: contact precautions (gown and gloves) for germs spread by touch, droplet precautions (a mask) for germs such as the flu, and airborne precautions (a special room and a fitted respirator) for germs such as tuberculosis.

Work from clean areas toward dirty areas. Carry soiled linen away from your uniform, never shake it, and never put it on the floor. Put used razors in a sharps container, and never share personal care items between residents.

Overview

This chapter covers keeping residents safe from falls, fires, and other emergencies. Questions often ask what to do first in an emergency and which actions prevent harm.

Most falls can be prevented. Before leaving a room, put the bed in the low position, lock the wheels, and place the call light within reach. Non-skid footwear, clear and well-lit walkways, and answering call lights quickly also help. Always identify the resident with the ID band or the facility's approved method before giving care.

If a resident starts to fall while walking, ease the resident to the floor and protect the head. If you find a resident on the floor, do not move the resident; stay and call the nurse. For a blocked airway, when the resident cannot speak, cough, or breathe, call for help and give abdominal thrusts. If the resident can still cough hard, encourage coughing and stay. During a seizure, protect the head and put nothing in the mouth.

For fire, remember RACE: Rescue, Alarm, Contain, Extinguish. To use an extinguisher, remember PASS: Pull, Aim at the base, Squeeze, Sweep. Keep flames and sparks away from oxygen, and take frayed cords out of use.

Overview

This chapter covers how to move residents and yourself safely. Questions often ask about good body mechanics, the names of basic positions, and how to set up a transfer.

Good body mechanics protect the aide's back. Keep the feet about shoulder-width apart, bend at the knees and hips, keep the back straight, and hold the load close to your body. Turn by moving your feet instead of twisting, push or pull instead of lifting when you can, and raise the bed to a comfortable working height.

Know the basic positions. Supine is lying flat on the back. Prone is lying face down. Fowler's position is on the back with the head of the bed raised. Sims' position is on the left side, rolled partly forward, with the upper leg bent. Logrolling turns the resident as one unit to keep the spine straight, and a lift sheet with two workers moves a resident up in bed with less friction.

Before a transfer, lock the brakes on the bed and wheelchair, and place the wheelchair close to the bed on the resident's strong side. A transfer belt goes over clothing at the waist, snug but with room for your fingers. When walking with a resident who has a weak side, stand on the weak side, slightly behind.

Overview

This chapter covers helping residents keep or regain their abilities. Questions often ask how to promote independence and how to use assistive devices correctly.

Restorative care means letting residents do as much as they safely can. Give extra time, keep needed items within reach, and praise effort. Doing tasks for a resident who could do them takes away independence, even if it is faster.

Range-of-motion exercises keep joints moving. Move each joint slowly and gently, support the limb above and below the joint, and stop and tell the nurse if the resident has pain. A cane is held on the strong side, opposite the weak leg. With a standard walker, the resident moves the walker forward a short distance and then steps toward it.

Bladder training uses a regular toileting schedule from the care plan, and accidents are handled kindly. Built-up utensils help residents with a weak grip feed themselves. When a leg prosthesis is removed, check the skin of the residual limb for redness or sores and report changes.

Overview

This chapter covers measuring vital signs, height and weight, and intake and output, and reporting what you observe. Questions often ask about normal adult ranges and when to report.

For adults at rest, a normal pulse is about 60 to 100 beats per minute and normal breathing is about 12 to 20 breaths per minute. The radial pulse is on the thumb side of the inner wrist. Count an irregular pulse for a full minute. Count breathing without the resident noticing, because people change how they breathe when they know it is being counted.

The average normal oral temperature is about 98.6°F (37°C). Rectal readings are usually highest and axillary (armpit) readings lowest. Normal adult blood pressure is below 120 over below 80, and a cuff that is too small can give a falsely high reading.

For intake, count anything that is liquid at room temperature, such as gelatin and soup, and use 1 ounce = 30 mL. Weigh the resident at the same time, on the same scale, in similar clothing. Pain is what the resident says it is, so report the resident's own rating. Report any sudden change, such as new confusion, to the nurse right away.

Overview

This chapter covers residents' emotional needs, dementia care, difficult behavior, and care at the end of life. Questions often ask for the most respectful and calming response.

Basic physical needs such as air, water, and food come first in Maslow's hierarchy, followed by safety, love and belonging, and self-esteem. Moving into a facility is a big loss, so help new residents with personal items, listening, and contact with others. Report signs of depression, such as withdrawal and loss of interest, and report any talk of not wanting to live right away while staying with the resident.

Alzheimer's disease is the most common cause of dementia and gets worse over time. Use short, simple sentences, one step at a time, and approach from the front. When a resident with dementia is upset, stay calm, speak softly, and redirect or try again later. Respond to the feelings behind confused statements instead of arguing about facts. Sundowning is increased confusion late in the day.

Anger often comes from fear or loss of control, so stay calm and listen. Dying residents may pass through denial, anger, bargaining, depression, and acceptance, in any order. Hearing is thought to be one of the last senses lost, so keep talking to a resident who no longer responds.

Overview

This chapter covers respecting each resident's religion, culture, and beliefs. Questions usually ask how to show respect without judging.

Give privacy for prayer and for visits from clergy or spiritual advisers. Handle religious items with care and ask before moving them. Learn how each resident prefers to be addressed.

Respect food rules that come from religion or culture. If a tray has a food the resident does not eat, report it so a suitable substitute is provided. Never push your own beliefs, joke about a resident's beliefs, or hide food from a resident.

Overview

This chapter covers talking and listening with residents and reporting information to the team. Questions often ask about residents with hearing, vision, or speech problems and about objective reporting.

Communication includes words and nonverbal signals such as facial expressions, gestures, and touch. Active listening means giving full attention, nodding, not interrupting, and restating what you heard. Open-ended questions, which cannot be answered yes or no, invite residents to share more.

For hearing loss, face the resident and speak clearly in a normal or slightly lower tone without shouting. For vision loss, say your name when you enter and tell the resident when you leave. For aphasia after a stroke, use yes-or-no questions, give extra time, and use pictures or gestures.

Report and record objective facts: what you see, hear, and measure, and the resident's own words in quotes. Do not record opinions or guesses. On paper records, correct an error with one line, your initials, and the date. In 24-hour time, add 12 to p.m. hours, so 3:00 p.m. is 1500.

Overview

This chapter covers the rights federal rules give residents of nursing facilities. Questions often ask how to respect choices, privacy, and dignity, and what to do about abuse.

Residents have the right to make choices about daily life, such as when to sleep and what to wear, and the right to refuse care. When a resident refuses, respect the choice, offer another time, and tell the nurse. Residents may keep and use personal belongings, receive mail unopened, and voice complaints without fear of punishment.

Residents have the right to personal privacy and to confidentiality of their records. Knock and wait before entering, close the door and curtain during care, and keep the resident covered except for the area being washed. Do not share resident information with visitors or discuss it in public places.

Residents have the right to be free from abuse, neglect, misappropriation of property, involuntary seclusion, and restraints used for discipline or convenience. If you see or suspect abuse, protect the resident and report it to the nurse or supervisor at once. Federal rules require the facility to report allegations involving abuse or serious bodily injury within 2 hours and other allegations within 24 hours.

Overview

This chapter covers the legal and ethical limits of the nurse aide's job. Questions often ask whether an action is within the aide's role and how to name a type of wrongdoing.

Nurse aides work within a limited scope of practice. They do not give medicine, change orders or the care plan, or do tasks they were not trained for. They politely refuse tips and gifts, and they keep resident information private, including never posting about residents on social media.

Negligence is a careless failure to give proper care that causes harm. Neglect is failing to provide the care a resident needs, such as leaving a resident wet for hours. Threats to withhold food or care are mental abuse, and taking a resident's money, even to 'borrow' it, is misappropriation of property.

Federal rules require state-approved training of at least 75 clock hours, including at least 16 hours of supervised practical training. Confirmed findings of abuse, neglect, or misappropriation are recorded in the state nurse aide registry. After 24 consecutive months without paid nursing-related work, a new training and competency evaluation program or a new competency evaluation program is required.

Overview

This chapter covers how the nurse aide fits into the health care team. Questions often ask who supervises the aide, what to do with an assignment, and which team member does what.

Nurse aides work under the supervision of a licensed nurse. The care plan and the nurse's assignment tell the aide what care each resident needs. The aide's observations matter because the aide gives much of the direct daily care, and they help the team build the care plan.

If you are asked to do a task you were not trained for, politely tell the nurse and ask for help or training. If a concern about a resident is not addressed, follow the chain of command to the next supervisor. Plan your shift from the report and assignment so urgent needs come first.

Other team members include physical therapists (walking and strength), speech-language pathologists (speech and swallowing), dietitians, and social workers. Federal rules require at least 12 hours of in-service training a year for nurse aides, including dementia management and abuse prevention.